1. Tomi St. Mars, MSN, RN, CEN, FAEN
Facility Recognition

2. Arizona
EMS for Children’s program opted to focus on regionalization/standardizing
90% of pediatric patients treated in an ED access via the front door
10% arrive EMS
Inclusive system improvement

3. AZ Goal – Inclusive System of Care
Voluntary System Developed by ED Nurses and Physicians using the “Guidelines for Care of Children in the Emergency Department”
Three tiers
Sustainability: Membership and Certification Fees
Consultation and Education
Quality Improvement

4. Levels of Care – Names not Numbers
Prepared Care - This level of certification provides services for pediatric care as part of a general Emergency Department.  The hospital refers critically ill or injured children to other facilities and may or may not have pediatric inpatient services available. 
Prepared Plus Care - This level of certification provides services for most pediatric emergency care. The hospital has a focus on pediatrics, but ICU services for children are not available. 
Prepared Advanced Care -This level of certification provides services for all levels of pediatric emergency care.  This hospital system includes a Pediatric intensive care unit and has a specific focus on pediatric services. 

5. Prepared Advanced Care
Tertiary facility
PICU
8 hours annual Pediatric CE
PALS & ENPC (Trauma Nurses if TC)
15% staff certified (2018)

6. Prepared Plus Care Community ED may have inpatient Peds PALS
25% ENPC (2018)
5% Certified (2018)
8 hours annual Pediatric CE

7. Prepared Care Foundation of all ED’s 6 hours of pediatric CE (2018)
PALS
5% ENPC
% of certification

8. Criteria
Physicians staffing Board-eligible or Board-certified in one of the allopathic or osteopathic boards of: Emergency Medicine, Pediatric Emergency Medicine, Pediatrics, Internal Medicine or Family Medicine.
Physician pediatric CME annually
Non-board-certified physicians are required to have current PALS or APLS certification.
Nursing staff must be licensed in the State of Arizona or multistate compact privilege.
PALS &/or ENPC certification within 6 months of hire.
pediatric CME annually
Blood pressures
Medication validation
Pediatric clinical pathway acute respiratory illness

9. Cont…
Guidelines
Disaster- needs of children are included in mock drills
Transfers
Abuse
Sedation
QI review:
All transfers out
All pediatric deaths
All child abuse/maltreatment
Required Equipment

10. Pediatric Prepared Emergency Care
April 2008 Stakeholder Meeting – Hospital CEOs, Emergency Department Leadership
2008 – 2010: Stakeholder Committee Meetings – review and refine criteria
Late 2010: Program transferred to AzAAP, Formal Steering Committee seated
December 2011: Initial site visits
March 2012: 7 Advanced Care sites, 2 Prepared Plus sites certified by AzAAP Board
May 2017: 41 Hospital Members, 32 Hospital EDs certified

11. Membership Benefits Members discussion forum
members share guidelines, procedures, issues and questions
Free educational classes and trainings
Certified Emergency Nurse Review Courses
Emergency Nursing Pediatric Courses
Advanced Pediatric Life Support, Newborn Resuscitation Program and/or STABLE
Identification and action on issues common to most or all EDs
Site visit participants share learning

12. Arizona Wins…. Next Steps – Life saved Standardizing care
Weights in kilograms
Improved child abuse policies
Mock codes
Disaster preparedness
Equipment in place
Clinical pathways shared
Improved flow
Next Steps –
Full set of vital signs on all kids
% nurses with CEN, CPEN
Postmortem guidelines
Identify joint QI targets
Continue to bump the bar moving evidence to practice faster

14. This graph illustrates the lower pediatric injury mortality rate of the certified hospitals compared to the overall emergency department mortality rate during the time period.

15. Rice A, Dudek J, Gross T, et al
Rice A, Dudek J, Gross T, et al. The Impact of Pediatric Emergency Department Facility Verification System on Pediatric Mortality Rates in Arizona. J Emerg Med Apr. DOI:
Smith, N., St. Mars, T. Woolridge, D. Arizona's Emergency Medical Services for Children Pediatric Designation System for Emergency Departments. J Emerg Med Aug. DOI:

18. Questions? Tomi.st.mars@azdhs.gov